MEETING THE PRACTICE CHALLENGE: IT’S A MATTER OF OWNERSHIP
CUTTING THE DISTANCE
CENTRE FOR PROFESSIONAL NURSING EDUCATION Photo by Bluefish Studios Inc.
WWW.M ac EWAN.CA/RN
GRANT M ac EWAN UNIVERSITY | SPRING 2010 | ISSUE 1
Accessible. Flexible. Relevant. MacEwanâ€™s Centre for Professional Nursing Education is dedicated to serving frontline multi-disciplinary practitioners who strive to improve the health and quality of individuals, communities, and industry. Programming is responsive to the needs of industry and practitioners as a whole. Many courses are offered online and through distance delivery, making professional development easily attainable. The centre also offers workshops that can be customized to suit the needs of corporations, organizations, and associations to help keep employeesâ€™ skills and knowledge sharp and current. Workshops topic areas include leadership, case management, clinical skills, CRNE preparation, best practices, and others.
DEANâ€™S MESSAGE The Faculty of Health and Community Studies is pleased to support the work of the Centre for Professional Nursing Education and the publication of Nursing PRN. Consistent with the mission of Grant MacEwan University, teaching and learning is our priority. Our faculty is dedicated to developing individuals in the helping professions with the aim of enhancing the health, safety, and well-being of our communities. We are committed to facilitating student learning through innovation and excellence in teaching, curricula, and technology integration. Whether you access our educational offerings in person at the Robbins Health Learning Centre in Edmonton or via an online environment, we look forward to welcoming you to MacEwan!
Sharon Bookhalter Dean, Faculty of Health and Community Studies Grant MacEwan University
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WELCOME! Welcome to the first edition of Nursing PRN. This publication provides us the opportunity to share our vision and stories with both new and old friends in the health care sector, across Alberta and Canada. Since 1973, MacEwan, with our innovative and accessible programming, has been preparing some of nursing’s best. Although much has changed since 1973, MacEwan’s faculty and staff at the Centre for Professional Nursing Education continue to promote excellence in patient care delivery by providing opportune and practical continuing education for nurses and other health care practitioners. Although as nurses we are committed to providing excellent care, the challenge of finding time to sort through all the available information and determine what is relevant is difficult when working 12-hour shifts and managing family obligations too. However, today more than ever—especially in our complex and ever-changing health care landscape—we need nurses to continue to work toward achieving professional expertise to maintain and improve the health and quality of life of individuals, communities, and industries. The faculty and staff at MacEwan’s Centre for Professional Nursing Education are committed to serving frontline practitioners’ education needs by offering timely, evidence-informed, and flexible programming that facilitates the advancement of nursing professionals’ knowledge and skills. The following pages profile some of our landmark programs and our dynamic and caring faculty and staff. MacEwan is known for its positive and supportive approach to creating a learnerfocused environment where student success is achieved. Join us as we celebrate our accomplishments in this inaugural edition of Nursing PRN.
Shirley Galenza, RN, BScN, MEd Director Centre for Professional Nursing Education Grant MacEwan University
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On the Cover 8 | Centre for Professional Nursing Education: We’re Ready! by Cynthia Dusseault 16 | Meeting the Practice Challenge: It’s a Matter of Ownership by Cheryl Mahaffy 24 | Education: Cutting the Distance by Lisa Ricciotti
7 | Nursing PRN Contributors 8 | Centre for Professional Nursing Education: We’re Ready! by Cynthia Dusseault
12 | Student Spotlight: Kim Carlson by Cynthia Dusseault 14 | Program Spotlight: Wound Management by Cheryl Mahaffy 16 | Meeting the Practice Challenge: It’s a Matter of Ownership
by Cheryl Mahaffy 22 | The Preceptor: From Nurse to Navigator by BJ Anderson 24 | Education: Cutting the Distance by Lisa Ricciotti 28 | Faculty Spotlight: Jane Ratay
by Lisa Ricciotti 30 | Centre for Professional Nursing Education: Areas of Study 32 | Research Spotlight by Cynthia Dusseault 34 | Staff’s Top Ten Courses
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Issue 1 | Spring 2010
Acknowledgements BJ Anderson, Marketing Consultant Charlene Barrett, Marketing Manager Sharon Bookhalter, Dean, Faculty of Health and Community Studies Gail Couch, Program Chair Shirley Galenza, Director, Centre for Professional Nursing Education Lindsay Kirstiuk, Graphic Designer Joan Mills, Academic Co-ordinator Nicole Simpson, Academic Co-ordinator Brendan Wild, Editor Amber Ozero, Cover Model Bluefish Studios Inc. Photography McCallum Printing Group Inc. A special thank you to student volunteers from the Bachelor of Science in Nursing program.
Nursing PRN is published by MacEwan’s Centre for Professional Nursing Education. Grant MacEwan University 9-206, 10700-104 Avenue Edmonton, AB T5J 4S2 780-497-5163 Contents copyright 2010 by Grant MacEwan University. No part of this publication may be reproduced without written approval.
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Contributors WHAT DOES IT TAKE TO SAVE A LIFE?
BJ Anderson BJ is the marketing consultant with the Faculty of Health and Community Studies at Grant MacEwan University. She is a journalism grad, is currently pursuing her English degree part-time at MacEwan, and enjoys writing for both work and play.
It takes a cool head and steady hands, but most importantly it takes the right training. MacEwan’s Life Support Training team can provide you with up-to-date skills and training in emergency medical education. Take one of our Heart and Stroke Foundation– approved courses, such as
Cynthia Dusseault Cynthia is an Edmonton-based writer with a health and an education background. A former medical radiation technologist and elementary school teacher, she realized that no matter what she did, she was drawn to any task that involved writing, so she decided, over a decade ago, to write full time. Since then, she has written for a variety of magazines, including The National Review of Medicine, University Affairs, Your Health, Education Leaders Today, Today’s Parent, Children’s Playmate, Western Grocer...and many more. She has also had a picture book for children published by Scholastic Canada, and has written copy for websites and numerous corporate clients.
Cheryl Mahaffy Cheryl Mahaffy launched the freelance business Words that Sing in 1996 with the goal of writing about things that matter. Her work has appeared in numerous magazines and several books, including the anthologies Big Enough Dreams, Edmonton on Location, and Outside of Ordinary. Co-author of Agora Borealis: Engaging in Sustainable Architecture, she also writes for a broad range of nonprofit, civic, and corporate clients.
• CPR, aka Basic Life Support • ACLS • PALS Courses are offered in conjunction with First Aid.
For information on upcoming courses, visit www.MacEwan.ca/LST
“When I was sick and quarantined in the hospital with meningitis, my registered nurse was phenomenal. She was a continuous presence in my healing process. She made my health her personal mission.” Catherine Savard
Lisa Ricciotti Lisa Ricciotti somehow didn’t follow the path of her mother and three of her four sisters, who chose nursing as a career. Instead, she’s an award-winning freelance writer, happily working from an Edmonton home base shared with three French bulldogs, a grumpy old English bulldog, and one very patient husband. While not a nurse, Ricciotti credits her sisters’ passion for nursing as the source of her keen interest in writing about health and medical matters.
Expert caring makes a difference. Research shows that expert caring delivered by registered nurses: » Shortens hospital stays » Prevents hospital deaths » Reduces hospital infections » Cuts wait times » Controls health care costs Get the facts at expertcaring.ca
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Photo by Bluefish Studios Inc.
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“We’re dealing with a lot of practical, continuing education needs, so we need to have nurses who are practicing, and who are experts in their fields, teaching nurses who are at the novice level.”
Centre for Professional Nursing Education positioned as “go to” facility for nursing professionals by Cynthia Dusseault
ffering continuing education to nurses isn’t new to Grant MacEwan University. For more than 30 years, the university has been at the forefront of providing frontline nurses with opportunities to maintain continuing competence. The Centre for Professional Nursing Education, which opened in the fall of 2007 in the state-of-the-art Robbins Health Learning Centre, welcomes nurses and other health care professionals to a new dimension in continuing education at MacEwan— one that is ultra-flexible, that incorporates the latest innovations in communications technology and distance delivery, and that can respond swiftly to the changing needs of the nursing profession.
Journey to the centre MacEwan launched its nursing refresher program in 1973. “It was one of the main things that we were noted for in continuing education,” says Sharon Bookhalter, dean of the Faculty of Health and Community Studies at MacEwan. “And this is still the ‘go to’ refresher program for all nurses in Alberta,” she adds. In the mid 1970s, however, the nature of the nursing profession shifted significantly. Specialties arose, and nurses sought ways to develop competencies beyond basic nursing. As Bookhalter explains, “The health region took on the responsibility of orienting nurses to these areas, but it was taxing their clinical people, and was becoming more and more difficult to do.” The Edmonton health region and the university entered into a mutually beneficial partnership to address the changing needs of nurses. The university began offering courses and programs in the specialty areas of extended care (gerontology) and occupational health.
Shifts in the nursing profession continued to take place, and the health region, health care associations, and the professional nursing association itself—CARNA (College & Association of Registered Nurses of Alberta)—called upon the university to do even more. MacEwan responded by tweaking existing programs and adding new ones. Extended care (gerontology) and palliative care were combined and renamed and now constitute the ministryapproved Post-Basic Nursing: Hospice Palliative Care/ Gerontology certificate program. Occupational health became a ministry-approved certificate program, as did the more recently introduced Perioperative Nursing program. The university developed its own certificate programs in specialty areas such as emergency nursing, critical care, and wound management; wound management recently received ministry approval. It also introduced many stand-alone courses and workshops in different specialty areas. Until 2007, various departments of the extensive Faculty of Health and Community Studies housed these diverse offerings. The construction of the Robbins Health Learning Centre provided the ideal opportunity to consolidate them in one place, with its own identity and its own name: the Centre for Professional Nursing Education. “Being here at the Robbins puts it all under one umbrella,” says Shirley Galenza, director of the centre. “We can work with the community more efficiently. We can better respond to the needs of nurses in the community as well as to the needs of our stakeholders—agencies that look to us for upgrading or continuing education opportunities. We can also engage in applied research.” With an average of 500 to 600 students engaged in learning at any given time, the centre offers courses, programs, and workshops for registered nurses, registered psychiatric nurses, licensed practical nurses, and a range of health care professionals involved in clinical practice.
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A commitment to excellence, responsiveness, flexibility, and innovation
Photo by Bluefish Studios Inc.
Nursing Refresher program launched
Photo by Bluefish Studios Inc.
The majority of the 25 to 30 faculty members at the centre teach part-time—for good reason. They’re all working in clinical practice. “We’re dealing with a lot of practical, continuing education needs, so we need to have nurses who are practicing, and who are experts in their fields, teaching nurses who are at the novice level,” says Galenza. She explains that the centre is constantly on the lookout for talented, experienced practitioners to engage as part-time instructors. The centre is responsive to the changing health care environment. “We try to forecast where the clinical needs will be, and where any gaps will be in terms of the education nurses require to meet those clinical needs,” says Bookhalter. She explains that the recent opening of the Mazankowski Alberta Heart Institute at the University of Alberta prompted the centre to develop its Cardiac Care Nursing program, which is currently awaiting ministry approval and is anticipated to launch in 2011. The centre developed its Wound Management program in response to a demand from the health region to address the high costs and the interdisciplinary care involved in this area.
Extended Care Nursing (Gerontology) certificate program launched
Occupational Health becomes certificate program
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“Flexibility is an essential factor that makes the centre unique among institutions that offer continuing education for nurses.”
learning sets the centre apart from institutions that focus solely on theory-based learning. This all translates into a “do it right and people will come” philosophy, and those people include the practicing nurses and health care professionals who seek continuing education opportunities, as well as the clinicians who share their expertise. With a sound understanding of the needs of today, an intuitive eye on the future, and a commitment to excellence and innovation, the centre is definitely doing it right, and is establishing itself as the “go to” facility, in Alberta and across the country, for continuing education in nursing.
Photo by Bluefish Studios Inc.
Flexibility is an essential factor that makes the centre unique among institutions that offer continuing education for nurses. “I believe our key role is to assist nurses in adapting to the changing environment—to be there when they’re looking for different practice, knowledge, and continuing education opportunities, and to facilitate them moving into different areas of the field,” says Galenza. A second factor that makes the centre unique is its hybrid approach to program delivery. Many courses involve a combination of print, online, and hands-on learning, but the focus is on innovative distance delivery. “We have evolved in our distance delivery,” says Galenza. “It’s not just correspondence. We incorporate online discussions, video streaming, synchronous chat, web conferencing…we use technology to its best effect so that students can engage in discussion with other students and learn not only from their instructors and the course material, but also from other peoples’ practices.” Some courses have lab components that require in-person attendance. One of the centre’s labs can be converted into an operating room. Emergency nursing students attend labs in which they engage in simulation activities such as triage and focused assessment. This practice-focused, hands-on, and experiential aspect of
“do it right and people will come” 2006
Extended Care (Gerontology) and Palliative Care combined into Post-Basic Nursing: Hospice Palliative Care/Gerontology certificate program
Perioperative Nursing certificate program approved by the ministry
Wound Management courses offered
Palliative Care certificate program approved by the ministry
2005 Critical Care courses offered
Perioperative Nursing certificate program launched
Wound Management Post-Basic certificate program approved by the ministry
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HT i n g f o r G I L T T SPO t she’s look tion
N xactly wha rsing Educa E D U ST tudent finds e fessional Nu BCIT s ntre for Pro Ce at the
ord of mouth steered Kim Carlson toward Grant MacEwan University’s Centre for Professional Nursing Education and to the 16-week distance education course that she started in January: Life Decisions and Moral Dilemmas. A thirdyear student in the Bachelor of Science in Nursing program at the British Columbia Institute of Technology (BCIT), Carlson found BCIT didn’t offer courses in the specialty area she was most interested in. MacEwan did. “I wanted to take something in palliative care,” she explains, “so it was suggested to me by a staff member at BCIT that I look at MacEwan’s program. He promoted MacEwan as a good place to do my specialty, because other students from BCIT have taken courses there and enjoyed them. There seems to be a good working relationship between the schools.”
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nth by Cy
Carlson registered for the full ministry-approved program, Post-Basic Nursing: Hospice Palliative Care/ Gerontology, at MacEwan. Her plan is to complete her current course and three more courses in the program before graduating from BCIT. This will provide her with the specialty credits BCIT requires for graduation. After graduating, Carlson plans to complete the course requirements at MacEwan to obtain the ministry certificate of specialization. Distance learning is something that Carlson is quite comfortable with. “I’ve done a lot of distance education, so I’ve kind of figured out what works for me,” she says, adding that because she’s doing a preceptorship this term—working with an RN in a hospital—it’s impossible for her to take traditional in-classroom courses. So, while she’s taking the MacEwan course, she’s also taking two distance education courses through BCIT.
“There’s also a lot of emotion involved,” adds Carlson, “because we’re all coming with different experiences, and we all have different feelings about different ethical situations. I think it benefits all of us to
Juggling a preceptorship plus three distance education courses is certainly no easy feat, yet Carlson conveys an unmistakable sense of confidence when she speaks about how she handles it all. “I find it takes, with distance education, a couple of weeks to really get yourself wrapped around the schedule, and get yourself kind of organized as to what days you need to designate to doing homework, because you’re missing that structure of going to a classroom each day,” she says. “I try to calendar in everything that’s due, and keep track of the cut-off dates for discussions.” Carlson says she has found the online discussions to be the most enjoyable aspect of the Life Decisions and Moral Dilemmas course. “They’ve given me an opportunity to hear information from people who are already RNs, and have been RNs for quite a while. I find that to hear what their feelings are—about some of the dilemmas that have come up as they’ve been in practice—is really beneficial for me as a student, to sort of get me thinking about what I may have to face once I’m actually working.”
“I try to calendar in everything that’s due, and keep track of the cut-off dates for discussions.”
engage in these discussions.” Based on the online participation, Carlson estimates there are nine registrants in the course, and she finds this small group size has given a unique quality to the discussions, making it possible for participants to really identify each other. “I think this will be very valuable,” she says, “because when you have thirty students, it’s hard to keep track of who’s who; but with only nine students, you can almost put a face to the name— without the face. You kind of get to know who people are, you remember their backgrounds, where they work…you start to remember each other.” Compared with other distance education courses she has taken, Carlson speaks highly of the structure and format of this one. She appreciates that the course uses a platform called Blackboard, which she has used in many of her previous distance education courses and finds easy to navigate. She explains that she received a print package a month before the course began and appreciated being able to peruse the material and find out what would be covered each week. “It was all nicely laid out,” she says, “and it seemed that the instructor made an effort to have all of the information there. She even had little extra snippets of information for every module, so that you could really think about what was coming next. I also find that she’s online a fair bit, so I feel there’s good support.” Once she has received her degree from BCIT, Carlson hopes to find a nursing position in the area of palliative care. “My passion is for individuals with HIV and AIDS, so my plan is to take what I’ve learned in palliative and apply it to the end-of-life issues that come with AIDS.” Carlson says she can envision herself working at St. Paul’s Hospital in downtown Vancouver. The hospital has a designated HIV and AIDS ward. If she doesn’t obtain a position there, she might choose one of the city’s long-term care facilities. “I’m leaving the door open a little bit right now,” she says, and she has time to think about it as she completes her degree program at BCIT, and immerses herself in several more distance education courses at MacEwan.
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Wound Management New certificate program focuses on the whole patient, not just the wound by Cheryl Mahaffy
or as long as she can recall, Colleen Scharnatta has been intrigued by wounds. So when her health region, Sun Country, in Saskatchewan, opened a new position for a skin and wound resource nurse, it fit her interests perfectly. To do the job well, though, she needed training. MacEwan’s online Wound Management program offered the best fit. Scharnatta enrolled in fall 2009, and the timing was ideal. The program’s laboratory component was just shifting from in-person training in Edmonton to live online sessions, eliminating 20 hours of round-trip travel time. What’s more, Scharnatta will be able to complete her practicum in Regina, strengthening links with experts there who support her work. Pleased with the introductory course, Scharnatta enrolled in the program’s second of five courses to learn more about chronic and problematic acute wounds. “The instructor was so knowledgeable,” she says. “I still contact her with questions that come up.” Jane Ratay, her instructor in both courses, is part of a strong network of wound care managers that is earning Alberta recognition, alongside Ontario, as a leader in this crucial specialty. A careful, holistic response to wounds can save dollars, make chronic wounds more bearable, reduce the number of amputations, and prevent death, Ratay says. “Even the loss of one limb, like a toe, creates a much higher risk of dying within five years. When we work with clients who’ve had wounds, sometimes for many years, and their wounds heal, it’s amazing— satisfying for everyone.” The network gained strength in the late ’90s, as experts worked with then–Capital Health to develop regional wound care guidelines. Seeing a need for more 14 | Nursing PRN | Issue 1 | Spring 2010
“We want frontline clinicians to learn more so they can keep more wounds from becoming chronic.” training in wound care than typical medical programs provided (less than an hour, in many cases), the group worked together to bring MacEwan’s Wound Management program to life. Launched in 2005, the program recently received provincial approval as a post-basic certificate program, the first in Canada for wound managers. “People with less severe wounds were plugging up our wound clinics because people on the front lines didn’t know how to deal with them,” says Dorothy Phillips, who has developed a course on drain sites, fistulas, and peristomal complications that will debut this fall. “Those with complex wounds who needed medical management by an interdisciplinary team had to wait up to six months for treatment. And we know the longer a wound exists, the longer it takes to heal. We want frontline clinicians to learn more so they can keep more wounds from becoming chronic.” Each course includes several live lab sessions that link students and their instructor via the Internet. Students form virtual groups to tackle case studies, often with the aid of photos. “We’ll describe what you would see, feel, and smell, and challenge the students to come up with holistic ways to manage the wounds,” Ratay says. Guest speakers address topics such as burns, infectious disease, diet, and dermatology to round out the learning. Between live sessions, students have other opportunities to interact remotely and review online resources. Even before achieving certificate status, wound management attracted nurses, physical and occupational therapists, and respiratory therapists. Some, like Scharnatta, are equipping themselves for new positions, perhaps in home care or wound clinics. Others serve populations at high risk for developing wounds, such as the frail elderly or people with diabetes. Many are managers or educators who share their learning with others. Now, the certificate can
serve as a stepping stone to more advanced training, and some universities may credit it as an elective in undergraduate programs. Scharnatta says she uses her wound management training every day. While well aware she’s still a novice in a complex and fast-evolving field, she now knows what questions to ask before treating a wound. Is it healable? If not, the treatment protocol could be quite different. What’s our goal? Perhaps a cheaper dressing applied more often will accomplish more than an expensive product meant to stay on longer. Most importantly, she has learned strategies for team-based holistic healing. “We’ve got to look at the whole patient, not just the wound,” Scharnatta says. “It’s like a big puzzle.” Putting the puzzle together takes an entire team, she adds, from the frontline nurse to the nutritionist, to the client and involved family or friends. That’s exactly what her instructors in wound management love to hear.
Wound Management courses HLST 350
Principles of Wound Assessment and Management (fall 2010)
Management of Chronic and Problem Acute Wounds
HLST 352 Clinical Application of Wound Management HLST 353
Drain Sites, Fistulas, and Peristomal Complications (fall 2010)
Vascular Assessment of the Lower Extremities (fall 2010)
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Photo by Bluefish Studios Inc.
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THE PRACTICE CHALLENGE:
It’s a matter of ownership by Cheryl Mahaffy
arly in her career as a nurse, Jan Schimpf provided a home away from home for a mother–daughter duo while the woman’s husband was in intensive care with a ruptured aneurism. As they agonized over his care, Schimpf learned lessons she still employs as senior operating officer at Edmonton’s Misericordia Community Hospital. “It wasn’t about the machinery,” Schimpf recalls. “For his wife, it was that he had a gown on, that he looked comfortable, that the nurse acknowledged her presence and asked her how she was. And they would have huge debates about how long they should wait before ringing again when nurses said they would call back but forgot.” The husband later died while undergoing a tracheotomy that his daughter, also a nurse, had reluctantly approved at Schimpf’s urging. Standing with that family, Schimpf saw firsthand that the things nurses say and do dramatically affect people’s lives. Working in critical care at the time, she also knew the challenges that could easily compromise care. The experience solidified her determination to seize every opportunity to grow as a nurse—or, as she puts it, to own rather than rent her career. “As an owner,” she says, “I’m going to respond to things very differently than if I feel I’m here for a short time and just renting.” Charting a nursing career has become more challenging in the decades since Schimpf’s career-shaping experience. Personal, employer, and regulatory demands vie for attention even as the very parameters of the profession shift. Where can nurses turn for the tools to own, not just rent, their careers? We put that question to Jan Schimpf and two other nurses who have ridden the rollercoaster that is nursing in Alberta: Nicole Simpson, academic co-ordinator for MacEwan’s Centre for Professional Nursing Education, and David Dyer, director of nursing at Glenrose Rehabilitation Hospital. Their stories offer evidence that nurses can address diverse demands when they see them as complementary rather than competing. Spring 2010 | Issue 1 | Nursing PRN | 17
The personal drive to grow When health care funding cutbacks struck in 1993, Nicole Simpson was the first nurse laid off by the Royal Alexandra Hospital. Freshly graduated from the University of Alberta (BScN, ’92), she refused to be thrown off course. Instead, she worked every shift she could find, signed up for every available learning session, and served as a research assistant for nurses completing PhDs. “My philosophy is to never stop learning, never miss an opportunity,” she says. “And if you aren’t happy doing what you’re doing, it’s time to make a change.” Such self-propelled progress from novice to expert practitioner is an integral part of life as a nurse, Simpson adds. “Maintaining and enhancing knowledge is something that is required, but it’s also something that draws you to nursing.” Yet peaks and valleys in health care spending make such progress anything but easy. During cutback periods, diminished opportunities prompt many nurses to leave their employer, or even the profession. When the economy zooms skyward, nurses have their pick of jobs but can suffer burnout from excessive overtime. Currently, nurses have more than ever to do at work— and fewer resources for professional development. This rollercoaster has also skewed the workforce. The Glenrose, for example, is left with what Dyer calls “a bimodal peak,” comprising nurses who are either very senior or quite new, with relatively few individuals in between. It’s a challenging environment for incoming nurses, Simpson says. It’s not unusual for new graduates armed with a bank of knowledge and a desire to ensure best practice to clash with experienced nurses who know the history and context behind the practice. “It’s not one group or the other that has to change,” Simpson says; “both have to somehow meld together.” Mentorships can bridge the generations and foster growth. At the Glenrose, mid-career nurses mentor incoming nurses, thereby engaging the two groups most likely to leave the profession. Senior nurses are encouraged to take advantage of an Alberta Health Services program that matches them with the senior administrator of their choice. Undergraduate employed nurses have a nurse coach who shapes them, collectively, into a supportive network. Nurses at all stages mentor the 400-plus students a year who spend time onsite. Stepwise opportunities for advancement also encourage growth, Dyer says: “We try to co-ordinate positions, so there’s a definite career ladder.” 18 | Nursing PRN | Issue 1 | Spring 2010
“It really is about giving everyone the tools to grow and branch out to other opportunities.”
In his own career, Dyer has very purposefully chosen positions that add to his expertise and involve excellent mentors. At each step he has soaked up leadership skills, most recently by working toward the Haskayne Executive MBA through the University of Alberta. “RNs are expected to take far more of a leadership role here than in the past,” he says. “But nursing leadership was not specifically taught when I was doing undergraduate work, so the challenge for me, and for us all, is to make that switch.” More than ever, nurses need to take ownership of their careers. “In the past, employers financially supported career-long learning and development, but we’re seeing a swing in the environment,” Simpson says. “If I want to work in pediatrics or wound care, I’m going to have to develop career goals and look at where I want to be and what I need to do to support that. Certainly education plays a big role—and our centre can help, because we offer learning that is flexible, current, and practice-based.”
Keeping pace with technology
The best-practice challenge More than 150 years ago, Florence Nightingale based her campaign for improved standards of care on evidence that clearly linked unsanitary hospital conditions with patient deaths. Nurses who strive for evidence-based (or evidence-informed) practice follow in that honoured tradition. “Nurses have always challenged themselves to make the best possible decisions for patients,” Simpson says. “And part of that challenge is using the evidence around us.” Yet many nurses cringe at the mention of evidencebased practice. Perhaps that’s because evidence tends to be defined narrowly as research-based science rather than the integration of the broad array of resources needed to inform wise decisions, suggests Simpson. “When the environment is becoming even more challenging, how do we encourage nurses to utilize technology, to utilize each other, to utilize all sorts of information to maintain and improve our practice?” Whether a nurse is engaged in leadership or bedside care, best practice is as much art as science, Schimpf says. “It’s about human interaction and touch. About patients and their families, and the stories that walk in the door with them. We are very good at teaching science and not so good about the art. And you need a blend of both.” Back in the 1850s, Florence Nightingale used her flair for statistics to prove that infectious disease was rapidly wiping out the British army in the Crimea. But it all began with a keen eye for her patients’ well-being and surroundings.
Misericordia intensive care staff rarely use the Swan-Ganz catheter to monitor heart function and blood flow. But when it’s needed, it must be used correctly. “How do you maintain people’s skill in the use of technology, especially for low-frequency, high-risk procedures?” Schimpf asks. “That is a huge challenge for nurses—and for us as an employer.” Finding a solution can be a juggling act. If another unit is proficient at the procedure, the patient may be moved there. Sometimes a more common procedure can be used instead. Staff may run through just-in-time training or participate in simulations. Whatever the solution, there’s no question that the rapid proliferation of technologies puts nurses in perpetual catch-up mode. The bimodal quality of Alberta’s nursing workforce becomes particularly apparent in this context. The Glenrose discovered as much after setting up an email account for every nurse on staff. Despite free drop-in sessions with a computer coach, many senior nurses struggled to catch on, Dyer recalls, “Yet young nurses will text their resumes to us from hotmail.com.” Both the tech-savvy and the tech-challenged have things to learn. The savvy may have no trouble navigating electronic systems that challenge their older peers, but they risk becoming so plugged in that human connection suffers, Schimpf says. “When your phone vibrates while you’re with a patient, you know it’s going to distract. And anything that may distract results in substandard care.” There’s also the reality that nurses struggle to find time (and free terminals) to take advantage of the wealth of resources available online. As H1N1 loomed, Misericordia emergency staff devised an intriguing strategy. They placed digital photo frames loaded with information about the epidemic atop the staff television and above medication dispensers. The staff not only paid attention, they retained what they read. Taking a cue from that success, Schimpf is laying plans to pilot learning loops in various high-traffic locations. “The tools we provide have to fit within the workday, and yet we’re asking people to do more and more,” she says. Sometimes, the solution is to slip the learning between the cracks.
“My philosophy is to never stop learning, never miss an opportunity.” Spring 2010 | Issue 1 | Nursing PRN | 19
Shifting scope of practice Challenged by Alberta Health Services to double its inpatient intake and accept more acute patients, the Glenrose is shifting nurses’ roles to make greater use of their expertise. The hospital is expecting nurses to provide more leadership on their units, turning routine care over to health care aides, and hiring two nurse practitioners. Similar shifts are occurring in many health care settings under such monikers as “optimizing scope of practice” and “full scope of practice.” Nurses are nervous, fearing loss of jobs to other health care providers and reduced patient contact. “This is not about reducing the ratio of nurses or pulling nurses away from patients,” Dyer says; “we’re just directing nurses to spend the majority of their time doing work they are educated to do.” Opportunities to interact with patients will shift from bathing and changing the sheets to the application of skills such as debriding a wound and mapping out complex discharge plans, he adds. “It’s about having the right nurse doing the right things for the right patient.” For the Misericordia, this change means adjusting the mix of caregivers in each unit, based on the complexity and uncertainty of patient needs, Schimpf says. For nurses, it means matching each patient with the individual best equipped to give the right level of care. That’s a significant culture shift, she adds. “Nurses feel their load should be balanced between light and heavy patients, rather than looking for the skill mix that’s appropriate. But because we are doing a lot of tasks that really should be done by another discipline, we’ve limited our ability to offer the most we can. All of it is great work. All of it’s meaningful. It’s just different. And the outcome is a holistically cared-for patient.”
Ensuring continuing competence Layered atop the expectations nurses put on themselves and the challenges they encounter at work is a third set of requirements imposed by regulatory bodies. Less than ten years ago, nurses simply needed to work a specified number of hours to maintain their registration. Now governments across Canada require regulated health care providers to demonstrate annually their continuing competence with the appropriate regulatory body. For nurses in Alberta, those bodies are the College & Association of Registered Nurses of Alberta (CARNA), the College of Licensed Practical Nurses of Alberta (CLPNA), and the College of Registered Psychiatric Nurses of Alberta (CRPNA). Nurses must report how they have maintained and enhanced their competence in the previous year and outline goals and plans for the coming year. “A lot of nurses believe it’s an extra thing they have to do, versus tying it into their overall professional development,” Simpson says. At the Glenrose, managers connect the dots by using continuing competence plans as a springboard for discussion during performance appraisals. “If your goals are related to what we can do onsite, we’ll do what we can to help,” Dyer 20 | Nursing PRN | Issue 1 | Spring 2010
says. That may mean grouping days off to make time for a course, for example, or seconding nurses to projects that build new skills. Regulatory bodies also set standards of practice and codes of ethics that can be a struggle to meet, particularly when resources are scarce. “It doesn’t matter what the staffing challenges are; every regulated health care provider is independently responsible for those standards of practice,” Simpson says. Nurses are also charged with advancing the profession by standing up for right practice and ethics and mentoring others, echoing employers’ call to leadership. “This isn’t about doing a certification process today and putting it away for a year,” Schimpf observes. “We are each accountable for what we do.”
Tying it all together Laden with personal, employer, and regulatory demands, how is a nurse to cope? “Look for ways to meet multiple challenges at once, rather than in a scattergun pattern, piece by piece,” Simpson suggests. To that end, Simpson convened a focus group of employers, educators, regulators, and nurses in February to take stock of the challenges today’s nurses face and to identify how MacEwan’s Centre for Professional Nursing Education can respond. The centre’s flexible mix of self-study modules, certificates, refresher programs, and specialty nursing programs is already attracting use by nurses, employers, and regulatory colleges. But Simpson is confident more can be done to meet emerging needs and spread awareness of the tools that exist at MacEwan and elsewhere. As a first step, the centre is revising course titles and outlines to clarify the specific challenges and standards each unit addresses. The centre also regularly consults with nurses who are charting their careers. That’s crucial work, Schimpf notes. “It really is about giving everyone the tools to grow and branch out to other opportunities. And this is where MacEwan can come in very, very well, by providing the knowledge and skills to work toward a transition.” In the end, it’s up to each nurse to own his or her career and devote the necessary energy to meet the practice challenge. “There will always be roadblocks, but nobody promised life would be easy, and in fact our greatest learning occurs during roadblock times,” Schimpf says.
VOICES OF EXPERIENCE STRATEGIES FOR CHARTING A BEST-PRACTICE CAREER Equip yourself to lead The day of RNs getting patients up and ready for the day will disappear, and the primary role of nurses will be as leaders on their units. They need to be working to prepare themselves, and employers certainly have responsibilities as well. - David Dyer
Learn on the run Education doesn’t have to be a formal sit-in-a-class setting. It can be a self-study module. Now I can go to my employer and say, “I took this course and I would really be interested in doing this related workshop, because it ties in with my goals.” - Nicole Simpson
Learn from every mentor We all have people we’ve worked with that have influenced us positively or negatively, and you learn from both. - Jan Schimpf
Use the tools CARNA has a new tool, the Nursing Intervention Classification, that lists everything nurses do and the level of education needed. Do nurses even know it exists? Yet this is a tool a nurse can use to ask, “Shouldn’t we be equipping ourselves to do these other things?” - Nicole Simpson
Be a patient change agent Change can take a long time, but if it’s what you believe, it will be yours to own when the time is right. - Nicole Simpson
Every job counts When I was a manager, I’d hear about it immediately when the unit clerk or service attendant wasn’t there. But I could be gone awhile and no one would notice. So for the ongoing business of the day, who really is more important? - Jan Schimpf
Don’t just say it, do it When people say “this is where I want to be,” I ask what they’ve done to get there. And if they’ve done nothing, I say, “Then you really don’t want to be there.” There are always opportunities to head in the direction you want to go. - Jan Schimpf Spring 2010 | Issue 1 | Nursing PRN | 21
The Preceptor: From Nurse to Navigator by BJ Anderson
or a nursing student, the learning curve in the classroom can seem steep. When stepping onto the floor of a busy hospital for clinical placement, the learning curve can appear insurmountable. However, to become proficient in the skills required to meet entry-topractice competencies, a lot of learning needs to happen in the real world, caring for real patients. It is in this realm of caring for real patients that the nursing student meets the preceptor. The preceptor’s role falls somewhere between teacher and mentor, educating through instruction and by example. The guidance of a preceptor is necessary to ensure that upon completion of clinical placement, the student is prepared for entry-level practice. Along with familiarizing students with the clinical environment, unit routines, and patient treatments, the preceptor provides opportunities for the student to cultivate some of the human elements that are intrinsic to the nursing skills of patient assessment, time management, effective communication with patients, and critical thinking. “Nursing students don’t hit the floor running, like in the past,” says Sharon Dawson, a registered nurse (RN) and clinical nurse educator at the Grey Nuns Community Hospital in Edmonton. A graduate of the University of Alberta, Dawson explains how this transition is even more difficult for a nursing student today than it was for her when she first stepped onto the floor 17 years ago. “Hospitals are busier, and nurses are expected to keep up with advancing technology and more complex medical interventions in patient care,” she notes. “People are living longer, and we are seeing a patient population with more acute illnesses.” This constantly evolving environment makes the role of preceptors more important than ever. At the same time, it puts greater strain on preceptors and on their hospital units. A preceptor not only holds responsibility for providing education to a student or new nurse, he or she must also maintain a high level of patient care and ensure it doesn’t suffer during the teaching process. 22 | Nursing PRN | Issue 1 | Spring 2010
Paired with the growing importance of the preceptor’s function as student navigator and coach, the sheer number of nursing students that require clinical placement has increased substantially over the years, putting pressure on a system short of RNs thought to be qualified for the preceptor role. The contrast between what constitutes the perfect preceptor candidate and an available candidate has hastened inevitable changes in what constitutes “qualified.” “Ideally, we would want a somewhat veteran nurse—a clinical expert in their area,” says Pauline Mitchell, an RN and instructor with the Nursing Refresher program at Grant MacEwan University. She explains the reality, however, is that such experts have often put in many years of nursing and have since chosen to move into part-time positions. Like MacEwan, most institutions need a full-time RN to fill the preceptor role to enable the student to meet the minimum required hours for clinical placement. As a result, nurses who may have only a year or two under their belts are being seconded to meet the increasing demand for preceptors; moreover, the same nurses are being rotated through preceptor roles more frequently than is desirable. A nurse who serves repeatedly as a preceptor runs the risk of “preceptor burnout.” Dawson points out the catch-22: “If you are a good nurse, you will probably be asked to fill the position of preceptor again and again.” The pressure of supporting and cultivating a series of teaching relationships, combined with the ongoing responsibility to patients and personal competency, can be exhausting. Some active treatment centres, like Grey Nuns, have had to limit the number of students they can accept at a given time as they seek to establish a better balance. However, despite these challenges, most nurses embrace this cycle of learning and teaching as part of their profession. “It is an expectation of our nursing profession to share our knowledge,” says Mitchell, whose own nursing background includes the position of clinical nurse educator in the neurosciences unit of the University of Alberta Hospital. Having worked on both sides of the divide, she understands the pressures and responsibilities that come with the preceptor role. “We really appreciate our preceptors,” Mitchell notes. Now, as one of two placement co-ordinators for nursing refresher students at MacEwan, she is willing to provide any needed support to a preceptor responsible for one of her students. Mitchell’s expectation is that the preceptor will keep an open mind, regardless of the student’s experience level—new or refresher—and
The preceptor’s role falls somewhere between teacher and mentor, educating through instruction and by example. will be the student’s eyes and ears during this portion of her education. But just as she expects students to take responsibility for meeting their own learning needs, Mitchell hopes that preceptors, too, find they learn from their preceptor relationships. Dawson agrees. “It’s a different and valuable perspective they bring,” she says, referring to refresher students in particular. Of students in general, Dawson says it’s her experience that ensuring students are happy benefits everyone, including the unit and the hospital. She explains that happy students are interested and engaged, encouraging their preceptors to search out new and interesting learning experiences to share. This in turn motivates and excites these professionals in their own careers. “If these students have a sense of belonging and community, they’ll want to come back to work here,” Dawson smiles. And perhaps as nurses, these students will someday find themselves on the other side of the clinical placement learning curve—as preceptors. Spring 2010 | Issue 1 | Nursing PRN | 23
: N O I T A C e U h t ED tting u C e c n a t s i D by Lisa
very working mom dreams of having the ability to be two places at once—and Colleen Scharnatta’s almost mastered that time–space conundrum. The multi-tasking mother of three is a regional skin and wound resource nurse in Saskatchewan, and her after-hours schedule is as busy as her work day. There are the kids’ hockey practices and tournaments, often with out-of-town travel; then, on top of those, she’s upgrading her nursing skills with a wound management course required by her new position. So what happens when Scharnatta’s must-attend class falls on the same evening as one of her daughters’ important games? Scharnatta doesn’t choose between the two—she does both. Although she lives in Estevan, Scharnatta’s wound management course comes to her online via Grant MacEwan University distance education. So when courses and rink time coincide, she packs her laptop along with the hockey gear, delivers her daughter to the arena, then finds somewhere to plug in. When in Weyburn she goes to her in-laws’; in Regina she works from a motel room. “I might miss part of the game, but not much,” says Scharnatta. “Distance education is perfect for my situation.” 24 | Nursing PRN | Issue 1 | Spring 2010
Defining Distance Education Liu and Scharnatta are just two of many health care professionals who’ve discovered they can fit additional training into their active lives with MacEwan’s online courses. For 30-some years, “availability, flexibility, and accessibility” have been the hallmarks of MacEwan’s off-campus learning programs. Today, technological advances and online course delivery are giving renewed meaning to those important benefits. “Broadly defined, distance education is any instructional system that doesn’t require students to be on campus,” explains Lynn Feist, MacEwan’s distance and distributed education co-ordinator. “It’s courses you can take anywhere, and often at any time.” Feist notes MacEwan began moving some distance courses online in 1998 and is now gearing toward offering complete credentials online, for both certificate and degree programs. “We do continue to offer some print-based courses for students who find computers intimidating or don’t have easy Internet access,” says Feist, “but increasingly, online is the best way to make content come alive for distance education.”
Not Your Parents’ Correspondence Course
“Distance education is perfect for my situation.” Distance education also eliminates the need for Jason Liu to be in several locations at the same time. The occupational therapist has two jobs—one at a local Peace River community health centre, the other at his own wound care and orthotics clinic. Passionate about increasing his wound management knowledge, Liu wanted to take seminars from MacEwan but didn’t have time for the six-hour drive to Edmonton. Now that the Wound Management program is online, Liu’s problem is solved. He simply fires up his home computer to join classmates from across Canada—no travel or time off work required.
Lynn Rogers is a MacEwan instructor who’s having a lot of fun putting that extra life into her online occupational health courses. “I can’t believe how different online distance education is today, compared to back when I took old-style correspondence courses,” affirms Rogers. “This is the wave of the future, nothing like the old binder and mail-in format. I’m really enjoying the increased student interaction.” Jane Ratay, an online wound management instructor, shares Rogers’ enthusiasm. “It was a little freaky at first, talking to dead air instead of faces,” Ratay says. “But that passed quickly. Online technology keeps me actively engaged with students for the whole term.” MacEwan’s online courses come to students’ computers via two Internet-based e-learning systems: Elluminate and Blackboard. Both enable instructors to connect with students in a virtual classroom that’s really not that different from a conventional campus setting. After registering, students receive a username Spring 2010 | Issue 1 | Nursing PRN | 25
ONLINE LEARNING LINGO Blackboard and Elluminate Web-based software programs that deliver online distance education courses to MacEwan students— complete with audio, video, chat functions, and social networking—in a collaborative learning environment.
eCampus Alberta A consortium of 15 Alberta post-secondary institutions, including MacEwan’s CPNE, offering online learning in more than 50 provincially accredited programs.
Readiness Survey A friendly, self-administered quiz that helps prospective distance education students determine if online learning is right for them. Click the icon in the Continuing Education section of MacEwan’s website: www.MacEwan.ca/countinuinged
Paced Courses Distance education in which course content is covered at a student’s preferred speed and schedule but still occurs within a set period, with a deadline, to ensure completion.
myMacEwan.ca A student’s personal MacEwan email account that provides access to Blackboard courses and materials, fellow students and instructors, the library, student news and services, schedules, policy manuals, grades, tax receipts, and technical support.
Engagement A side effect that comes from interacting with students and instructors online. Can be highly addictive, although very beneficial to a student’s health.
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and password to log on to MacEwan’s portal, where detailed instructions from program advisors help them get started. Once set up, students can access all course outline materials, as well as useful links, library resources, and tutorials that explain how to use Blackboard and Elluminate. Instructors also ensure all students are comfortable with these applications during the first group session. Students are encouraged to post brief profiles of themselves, and a photo if they like, to get acquainted with their cyber colleagues. Ratay presents her classes in PowerPoint format with live narration as she covers the material. Students can respond to her—and each other—by voice or by typing, all in real time. Because wound management is a highly visual field, Ratay posts many photos for students, who can also watch videos of speakers taped at MacEwan’s campus, or be joined live online by a guest expert. Ratay often uses case studies in her classes, dividing students into smaller groups for separate chat room discussions, then bringing them back together to share results. Ratay also draws on links to outside websites and may include online quizzes during the two-hour sessions. Classes are generally limited to 25 students to keep communication manageable. Students can see who’s online, and each student is digitally identified when speaking or texting. To prevent everyone from “talking” at once and creating chaos, students click a button that lets them “raise their hand” for questions, much like standard classroom etiquette. Ratay’s course includes marks for online participation, providing further incentive for student involvement. Rogers likes that idea, but says her course doesn’t include that extra motivation—yet.
Interactive Learning Students learn from their instructors, but online technology also lets them learn from each other. Rogers notes that occupational therapists, for example, are often the only such professional in their workplaces, so these students love to compare notes and draw on each others’ career experiences online. Students can contact each other privately, but most post their questions in chat groups that continue between scheduled classes. “Distance students who take classes together often form a strong network,” says Feist. Some teachers even go one step further, creating online “social cafes” or “water coolers” where students discuss non-course matters, such as where to find a good hotel in a city their work takes them to or their plans to meet when in the same area. “In traditional distance learning, students weren’t expected to participate,” says Rogers. “But now technology makes ongoing interaction possible.”
Ratay noticed that depending on their personalities, some students jump in quicker than others, “but all it takes is one leader to get them going. The more tech-savvy they become, the more they interact.” Instructors know distance education students can feel isolated and so work hard to create a community atmosphere. “If instructors notice someone’s not participating, they’ll send a private email or call the student to find out why,” says Feist. “But generally teachers feel they get to know students better online than in a regular class setting.” Engagement certainly isn’t a problem in either Rogers’ or Ratay’s experience. “The younger generation loves the chat function and uses it constantly,” says Rogers. “Because we’re always talking, I find it easier to see if they’re understanding information and where I need to clarify or give encouragement.” Ratay finds she’s never out of touch with students, receiving emails at all hours through Blackboard or on her personal Blackberry. “I answer every one,” she confirms. Because many Centre for Professional Nursing Education (CPNE) programs are quite specialized, its courses attract students from across Canada and even beyond. “I have students from Winnipeg and Whitehorse, in B.C. and New Brunswick,” says Ratay. Rogers notes she “often has students from Newfoundland, and from Victoria to Ontario.” Instructors can be delivering their courses from any location, too. Rogers now lives in Ontario, but she winters in Arizona and continues to instruct during her RV travels from there to Texas. This winter Ratay connected with students as her sailboat navigated the Florida Keys. Technology brings them together across kilometres and time zones. They may not physically be in two locations at once, but thanks to online distance education, that’s no longer a problem.
“...availability, flexibility, and accessibility...”
Do I Have to be a Geek? “I’m no computer whiz,” says distance education instructor Lynn Rogers, “but an hour with tech support was all it took to get comfortable teaching online. The application is intuitive enough to pick up easily.” Regardless of a student’s previous cyber skills, “people generally figure things out on their own, no problem,” says Lynn Feist, MacEwan’s distance education coordinator. “If they’re willing to try the technology, most succeed. Technology won’t stand in their way.” In addition to online Blackboard and Elluminate tutorials, students have easy access to MacEwan’s
Technology Support staff. “They’re fast,” says Feist. “And most problems are easily solved. Usually it’s a simple issue, such as switching to a different browser, resetting a pop-up blocker, or installing Flash or Adobe.” Rural computer users with slower dial-up Internet sometimes encounter difficulties, especially when viewing videos. “Some solve that by using a work computer or visiting a friend with hi-speed Internet for the classroom sessions,” says Feist. It’s more challenging, but where there’s a will, there’s a way. Spring 2010 | Issue 1 | Nursing PRN | 27
Wound Management Instructor by Lisa Ricciotti
id she approach Grant MacEwan University first or did MacEwan contact her? Jane Ratay doesn’t remember. All she knows is that since becoming a MacEwan instructor in the Wound Management program, she’s found her niche. Growing up as an only child, Ratay’s favourite game was playing school, being “teacher” to a neighbour’s five kids. “MacEwan is my first formal education position,” says Ratay. “But I’ve always loved teaching. Even as a young nurse, I liked helping others learn. I’ve done a lot of mentoring and preceptoring throughout my career. I’ve always been that kind of person.” In fall 2009, Ratay became one of MacEwan’s first instructors to pilot distance education courses online for wound management. To her surprise and delight, she found cyber-teaching even more satisfying than the face-to-face seminars she’d taught previously. “Before, I’d 28 | Nursing PRN | Issue 1 | Spring 2010
have intense interactions with students for one weekend, followed by a six-week period with not much contact until the next onsite session,” Ratay explains. “Now that the course is online, we have continuous involvement over the whole term. I’m always answering questions, working on new case studies, and updating presentations. I think ongoing engagement is a healthier way to learn and share.” Fortunately for her students, Ratay has boundless knowledge to share about wound care. Trained as a nurse in Pennsylvania, Ratay and her engineer husband emigrated to Edmonton in 1976 after falling in love with Canada during their Montreal honeymoon. With no intensive care experience, Ratay plunged into ICU nursing at the University of Alberta Hospital. “I just jumped right in,” Ratay explains. That enthusiasm is a Ratay trademark. “Friends say I’m like a swimming duck—calm on the surface but paddling like mad underneath.”
Ratay taught many of her recent courses from the deck of their 40-foot sailboat, during a 10-week voyage in the Florida Keys and the Bahamas. Ratay worked in ICU for four years before her drive for new experiences led her to endoscopy nursing at Misericordia Hospital—first in emergency, later in the gastroenterology medical day ward. Then with 15 years’ seniority under her belt, Ratay experienced a life-changing shock. Like many nurses, she was abruptly bumped from her position during the health care shake-up of the 1990s. “I was angry and resentful,” Ratay says frankly. But she quickly regrouped, paddling off in a new direction. She joined an outpatient ambulatory surgery unit, and a few short months later, opportunity knocked: “I was asked to help develop a chronic wound care clinic at the Misericordia.” Once again, Ratay dove right in. “I liked the challenge of starting something. At the time, the city’s only wound clinic was at the Royal Alexandra Hospital. It was all so new; we really didn’t know what we were doing. But we quickly figured it out, during a very exciting time.” It was also an extreme eye-opener for Ratay. “Patients had the worst chronic wounds I’d even seen—the worst I’ve still ever seen. Some had lived with open wounds for 30 years.” Ratay soon realized wound management was an overlooked area of patient care, in spite of its vital importance. “These patients deserved a better quality of life. I saw a way to really help people, to make a difference. There were so many rumours and myths about how to treat wounds, and no real guidelines. I wanted to be part of taking wound care from a helter-skelter approach to an organized specialty.”
Ratay admits when she started at the clinic she “had no interest in wounds whatsoever.” But then it became her passion. “I went to every conference and seminar I could. I wanted to learn everything about this field.” She trained for 40 weeks in South Carolina and took the International Interprofessional Wound Care Course (IIWCC) in 1999, the first year it was offered. She also became involved with Alberta’s regional wound care guideline committee. And as she turned 50, she decided it was time to finish her BSc degree. Ratay went back to school full time, completing her post-RN degree in 10 months and earning a scholarship for further studies. She used it two years later to complete an 18-month online course in advanced wound care from the Canadian Association for Enterostomal Therapy (CAET). “It’s been a journey,” Ratay reflects, looking at her path from a basic understanding of wound care to making wound management her professional focus. “Every wound is different. Figuring out the best approach is like solving a puzzle. It’s fascinating because it requires a holistic, multi-disciplinary approach. As we say in this field, you have to treat the whole patient; you’re not just treating a hole.” Ratay is encouraged to see growing interest in wound care from nurses in diverse settings, including occupational therapists, physiotherapists, and others. “Currently nurses receive about 45 minutes of woundcare training during their entire education. But wound care generally falls to nurses, since doctors don’t have enough time. Now that MacEwan has Canada’s only Wound Management certificate program, interest will grow exponentially. It’s really becoming a specialty.” While Ratay keeps her wound-care clinical experience current by working one day a week at WestView Health Centre in Stony Plain, she’s enjoying the flexible lifestyle that online instruction makes possible. “My husband’s transitioning to retirement, and now I can take long trips with him, while still teaching.” In fact, Ratay taught many of her recent courses from the deck of their 40-foot sailboat, during a 10-week voyage in the Florida Keys and the Bahamas. Still, she isn’t ready to join her husband in retirement any time soon. “I really enjoy teaching and want to keep finding better ways to better engage my students,” Ratay says. “And who knows, I might do a master’s. There’s lots to learn yet.”
Spring 2010 | Issue 1 | Nursing PRN | 29
Centre for Professional Nursing Education Areas of Study The Centre for Professional Nursing Education offers a wide variety of flexible, accessible, and relevant post-diploma/degree programming, specialized programs and workshops, and individual courses in many subject areas for nursing and health care professionals: Audiometric Technician
Best Practices Workshops (will contract to meet agency needs)
Human Anatomy Human Physiology
Clinical Skills Updates Compassionate Care for the Terminally Ill Critical Care Nursing
Human Sexuality IV Therapy Life Support Training
CRNE Preparation Workshops Disability Management in the Workplace
Medical Surgical Nursing Microbiology
Every Nurse Leadership Every Nurse Leadership Essentials
• Everyday leadership in clinical practice • Everyday leadership in administration • Everyday leadership in education • Everyday leadership in research • Everyday leadership in policy
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FALL 2010 Grant MacEwan University 10700 - 104 AVENUE EDMONTON, AB Contact: nicole simpson, academic CO-ORDINATOR simpsonN9@macewan.ca
Attend for: Practical skills development Continuing competence Professional development Career advancement
Nurse Credentialing Nursing Research Special Studies: Mental Health, Medical and Surgery, and Pediatrics Obtaining Blood Samples Occupational Health Nursing Perioperative Nursing for LPNs Perioperatiave Nursing for RNs Post-Basic Nursing Practice: Hospice Palliative Care and Gerontology Professional Development Modules Spirometry Technician University Transfer Courses Vision Screening
For details regarding specific course offerings, visit www.MacEwan.ca/RN
Wound Management Post-Diploma Certificate
Seeking a new challenge and direction? Perioperative Nursing could be your next step. Gain both theoretical knowledge and clinical skills to work in a challenging and team-oriented environment â€“ the operating room. RNs can complete the post-diploma certificate and LPNs can complete the four-course certificate online and through distance delivery, providing a flexible and accessible learning opportunity.
Visit www.MacEwan.ca/RN for more information. Spring 2010 | Issue 1 | Nursing PRN | 31
Research Project: The Effectiveness of the Canadian Registered Nurse Examination Prepatory Workshop for Internationally Educated Nurses by Cynthia Dusseault he Canadian Registered Nurse Examination (CRNE) is a rite of passage for nurses in every province except Quebec. Only after passing this national licensing exam can a nurse hold the RN (Registered Nurse) designation in this country. For 14 years, Grant MacEwan University has been offering a three-day workshop to help nurses prepare for this rigourous exam—an exam that poses exceptional challenges for internationally educated nurses (IENs) who are new to Canada and unfamiliar with the Canadian health care system. Recently, the university had the opportunity to formally study the effectiveness of the workshop for IENs. In late 2007 and early 2008, Capital Health (now Alberta Health Services) embarked on a recruitment campaign to bring to Alberta an estimated 750 IENs from Australia, the United Kingdom, and the Philippines. 32 | Nursing PRN | Issue 1 | Spring 2010
The health region contracted MacEwan to provide the CRNE preparatory workshop for these recruits. The staff and faculty at MacEwan’s Centre for Professional Nursing Education, which runs the workshop, recognized the potential to utilize this unique cohort of workshop attendees to develop a formal research project. “Anecdotally, we have had students email us and phone us, say they’ve passed the exam, and tell us how helpful the workshop was,” says Gail Couch, program chair at the centre. “We’ve been receiving comments like these for years. The goal of this research project is to validate this anecdotal evidence, and thereby validate the effectiveness of the CRNE preparatory workshop.” Engaging in applied research is a key goal of the Centre for Professional Nursing Education. “Research projects strengthen our partnerships with Alberta Health Services and with CARNA [College
& Association of Registered Nurses of Alberta], and support the need for, and determine the direction of, professional nursing education,” says Couch. This particular research project received funding from the Alberta Association of Colleges and Technical Institutes (AACTI), with matching funding from MacEwan itself. Recruited IENs who attended preparatory workshops sponsored by Alberta Health Services between March 1, 2008, and June 30, 2009, constituted the research project’s sample. The research team utilized an evaluative research methodology that involved administering two questionnaires to the IENs. Participants completed the first questionnaire immediately after attending the three-day workshop. This was a written questionnaire designed to solicit feedback regarding how useful they thought the workshop was in terms of preparing them for the CRNE, and how they felt about the workshop presentation. Approximately six weeks after writing the CRNE, by which time the participants had received their exam results, a research assistant administered the second questionnaire by telephone. “The second questionnaire asked the IENs, first of all, if they had passed the CRNE,” says Kari Krell, a faculty member at the Centre for Professional Nursing Education and a researcher on the project team. “Most importantly, however, it elicited qualitative feedback regarding how useful they felt the workshop had been in preparing them to write the exam—so, how useful the materials, content, and presentation had been. It also asked them about areas of the workshop they found the most helpful, and how they thought the workshop could be improved to make it more helpful.” Although any nurse seeking the RN designation can take the CRNE preparatory workshop, it is invaluable for IENs. Couch explains, “The internationally educated nurses are particularly challenged because the Canadian health care system is very different from the health care systems in the countries they were educated in, or have been practicing in.” She outlines the workshop’s five components—professional practice, health promotion and illness prevention, alternatives in health, introduction to Canadian RN practices,
“Anecdotally, we have students email us and phone us, say they’ve passed the exam, and tell us how helpful the workshop was,” says Gail Couch, program chair.
and community nursing—and points out how, for an IEN, learning about these aspects of the Canadian health care system is critical to passing the CRNE. Couch and Krell are currently analyzing the questionnaire responses. Once the analysis is complete, they intend to publish the findings in a nursing journal and will use the participant feedback to help the centre modify the workshop to increase its effectiveness for future participants. In terms of future research possibilities, Krell says, “There are a variety of topics relating to IENs that we would like to explore. For example, it would be valuable to have an understanding of how they adjust to working in the Canadian health care system, and how the centre might help in providing them with continuing education opportunities that help them adjust. Research projects in this area would help us determine if there is a need to develop continuing education courses and workshops specifically for IENs.” With the Canadian Nurses Association projecting a nursing shortage that is expected to worsen over the next decade, it indeed makes sense for the Centre for Professional Nursing Education to engage in research that enhances its ability to provide quality continuing education opportunities for IENs, who comprise a valuable segment of Canada’s health care system. Nursing PRN will bring you a results update on the CRNE prepatory workshop research project in the near future.
Spring 2010 | Issue 1 | Nursing PRN | 33
Centre for Professional Nursing Education Staff’s
TOP TEN COURSES These MacEwan course titles seem simple enough, but what happens when they are embellished a bit? They can become confusing and incredibly wordy...or should we say, “perplexing and absurdly verbose”? Match each easy-to-read course title below with its hard-to-decipher counterpart. Good
1. Initiation of IV Therapy
A. Accountable Attending
2. Responsible Nursing
3. Pain Assessment and Management
B. Wellness Program Administrators Elementary Entity Assistance
4. Principles of Wound Assessment and Management
5. Dementia Care in the Elderly
6. Assessment of Major Body Systems
7. Nursery Orientation Series
8. Basic Medication Administration
9. Health Care Providers BLS
10. Essentials of Pathophysiology
C. Arboretum Assimilation Seminars D. Fundamentals of Injury Appraisal and Governance E. Evaluation of Predominant Anatomical Alignments
F. Elementary Pharmaceutical Application G. Commencement of Trailing-Vine Treatment H. Mental Nurturing for the Well-Seasoned I. Affliction Evaluation and Administration J. YIKES! Answers: 1-G, 2-A, 3-I, 4-D, 5-H, 6-E, 7-C, 8-F, 9-B, 10-J
34 | Nursing PRN | Issue 1 | Spring 2010
Grant MacEwan University offers print-based self-study registered courses to health care professionals wishing to renew/advance their nursing practice knowledge. Course offerings: • Nursing Orientation, Resources, Review and Update (up to 24 different courses) • Level II Nursery Orientation: These modules contain the keys to accurate assessment and interventions for Special Care Nursery, Level II Nursery, and Neonatal Intensive Care Unit nursing staff who care for the newborn. • • • • • • • • • • • • •
Advanced Nursing Skills Initiation of Intravenous Therapy Theory IV Therapy Lab Medication Administration by IV Push Newborn Health Assessment Support of the Breastfeeding Dyad Interpretation of Laboratory Tests & Diagnostic Procedures Mental Health Disorders Obstetrics Oncology Pediatric Nursing Gerontological Nursing Trauma Nursing
For more information call 780-497-4511 or visit www.MacEwan.ca/RN
Spring 2010 | Issue 1 | Nursing PRN | 35
If teamwork motivates youâ€Ś
Your Calling is at Human Resources Toll Free: 1-877-450-7555 CovenantHealthCareers@covenanthealth.ca MacEwan Nursing PRN ad.indd 1
CovenantHealth.ca 4/1/2010 3:45:18 PM
Published on May 10, 2012
Nursing PRN magazine shares the stories and interesting activities occurring within the Centre for Professional Nursing Education at Grant M...